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Manifestations of Exterior Excess Syndrome. During the initial stage of fever, there is high fever without sweating, aversion to cold, headache, and body pain; the pulse is floating, tight, and rapid. This resembles conditions during winter when cold is predominant, and Ren Shen Bai Du San (Ginseng Decoction for Resolving Toxins) is indicated. If the season is warm and hot, Sheng Ma Ge Gen Tang (Bupleurum and Kudzu Root Decoction) is indicated. If the weather is neither cold nor hot but mild, Chai Gui Yin (Bupleurum and Angelica Decoction) is indicated. However, these are suitable only for patients with exterior excess. If a patient has a constitutionally deficient physique, or the exterior pathogenic factor is not severe, or the limbs are moist, or the rash spots have already appeared, even Sheng Ma Ge Gen Tang should not be used, let alone Ren Shen Bai Du San. If misused as a diaphoretic treatment, it will inevitably lead to ulceration. Secondly, if the face is red, lips are purple, eyes are red, nasal congestion occurs, skin is dry and scorched, complexion is red, and hands and feet are extremely hot, Sou Du Jian (Toxin-Searching Decoction) is indicated, possibly with added Chai Hu (Bupleuri Radix), or Chai Gui Yin is indicated. If spots have appeared, yet the rash color is red-purple, swollen and painful, or the skin is thick and hard, or carbuncles and sores form, and the pulse is floating, surging, slippery, and full, indicating that interior qi is also excess, Si Wei Xiao Du Yin (Four-Ingredient Toxin-Resolving Decoction) or Niu Bang Zi Tang (Arctii Fructus Decoction) are indicated. If spots have appeared but fever persists, Zi Ying Qi (Nourishing Ying Qi) is required, using Xiong Gui Tang (Ligusticum and Angelica Decoction); one must not recklessly use dispersing and releasing methods, as reckless sweating can cause ulceration. Be extremely cautious. If spots have appeared but were accidentally affected by wind-cold, causing slow eruption and increased fever, mild release of the exterior is indicated, using Chai Gui Yin.

Manifestations of Exterior Cold Syndrome. The rash fails to erupt, lacks redness and vitality, and the base (root area) is pale white. Bao Yuan Tang (Protect the Origin Decoction), Liu Wu Jian (Six-Material Decoction), or Ren Shen Nei Tuo San (Ginseng Interior-Supporting Powder) are indicated, with a small amount of wine added for decoction. If the rash has erupted but the body feels cool and itchy, with collapse and dryness, large doses of Bao Yuan Tang, Liu Qi Jian (Six-Qi Decoction), or Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction) are indicated, also with a small amount of wine added for decoction. If there is no response, add Lu Rong (Cervus Nippon Cornu) and Fu Zi (Aconiti Lateralis Radix Praeparata).

Manifestations of Exterior Heat Syndrome. Skin is very hot, breathing is coarse with panting and chest fullness, restlessness, mania, and delirium occur. Qiang Huo San Yu Tang (Notopterygium Decoction for Dispersing Stagnation) or Chai Gui Yin are indicated. If external heat is severe but lips are moist and thirst is absent, eyes lack red vessels, urination and defecation are normal, and although the body is very hot, the spirit is listless, Chai Gui Yin is indicated. If the rash has emerged but the base is red-purple, Si Wu Tang (Four-Material Decoction) or Liang Xue Yang Ying Jian (Cool Blood and Nourish Ying Decoction) are indicated. If spots have appeared but the apex is red and vesicular, Liang Xue Yang Ying Jian or Xi Jiao San (Rhinoceros Horn Powder) are indicated. If the head and face are swollen and red, turning purple-black and scorched, Zi Cao Kuai Ban Tang (Arnebia Rapid-Rash-Decoupling Decoction), Liang Xue Yang Ying Jian, or Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill) are indicated. If complicated by sand-rash, with red eyes and cracked lips, Liang Xue Yang Ying Jian is indicated.